How can hospital administration be so bad? Someone please explain it to me.

[HospitalHassler]

I'm waiting for surgery as I have severe endometriosis, a large ovarian cyst and complications due to adhesions. As is common with many endo sufferers, it took me years to get a diagnosis (thanks to my GP and that good old IBS diagnosis), before a trip to A&E finally got me seen by the right people. I had surgery last year, but the cyst has returned and I've been referred to an endo specialist for extensive surgery.

I'm in constant pain, it impacts my life daily, and I'm nearly 40 and have been trying to conceive for years. So it's a shit situation which I'm desperate to sort out.

But I'm being held up and tripped over at every hurdle, seemingly by a combination of incompetent staff and a clunky administration system which has allowed me to fall through the cracks. My experience so far:

Cockup #1 - Secretary panics, delays my referral, and then forgets to send it

I saw the consultant in August, and was told I was being immediately referred. After several months of patiently waiting, I called and asked a couple of questions about my referral. The secretary panicked, and decided that my questions warranted a further appointment with the consultant (they didn't), told me that I had to see the consultant because he needed to talk to me about something (he didn't, she totally lied) and that he wouldn't send my referral until he had seen me (another lie).

I complained to the hospital and spoke to the consultant, who agreed with me and apologised that the secretary was a 'low grade staff member who didn't understand the questions I was asking'. Which begs the question how the fuck was she able to make decisions which directly resulted in further delays to my treatment.

I was then told that the hospital 'forgot' to send my referral to the specialist. The consultant had in fact dictated my letter within days of seeing me, but that secretarial staff never typed it up and it didn't get written or sent until I reminded them to do so.

I finally saw the surgeon in December, and was referred to a second surgeon for investigations (I need multi-disciplinary surgery so both surgeons have to see me). I saw surgeon #2 in February. I was told that all that remained was for surgeon #1 and surgeon #2 to liaise and come up with a date.

Cockup #2 - Fallen to the bottom of the in-tray?

I have been calling regularly to ask for progress, and there has been none. Until a couple of weeks ago. I spoke to yet another secretary who reviewed my notes, put me on hold for a few minutes, then came back with "All I can say is I'm so sorry, we'll be writing to you asap". I took this to mean that there had been a cock up, they had forgotten me and were about to rectify that immediately.

Cockup #3 - You've done WHAT with my file?

I waited for that imminent letter, it didn't arrive. So I called again... spoke to a different secretary who told me that they were trying to get my case reviewed but were having trouble locating my case notes. Yes, my case file was currently missing. They. Had. Lost. My. File.

I immediately contacted the customer complaints department, spoke to a wonderful man who made it his mission to find my file. He found it within a few hours. It was the day of the Jr Doctors strike, and I apologized to him for hassling him on what was surely a busy day. He said that it was a bit bonkers that day, but he couldn't do much about it, so he was happy to be able to focus on the things he could help with and felt that helping me was a job well done. I could have cried.

Cockup #4 - it takes how long to sign a form?

So my file has been located and I spoke to the secretary again this week. She said all that was needed for the consultant to sign my form and then it could go to the team to schedule a date for me. Yes that's right, it has taken 2 months (and counting) for a consultant to sign a form.

Then she launches into this spiel about how there are thousands of other women in the same position as me, and some of them have waited years for diagnosis (you don't say!) so I just need to be patient!

Please could someone come and explain to me how hospital administration works, how files can go missing, how a secretary can make decisions on whether you ought to be referred or not, and how it can possibly take so long to get a man to sign a form? And can someone please explain how the listing system works - is there a queue, and will I go to the bottom of it as of next week when they hopefully, finally, receive the instruction to put me on the list?

I'm exasperated. I am extremely grateful for the NHS and I have no doubt that many of the issues are caused by under-resourcing and clunky systems (I work in civil service, I get it). I think if I could just understand how the system works, it might help me calm down a little.

My experience of NHS admin as a patient hasn't been too bad (confusing, unhelpful but not actually detrimental to my health), however my involvement with NHS admin as a volunteer who was eligible for expenses to be paid...well it is impossible.
Two years to pay a small amount of expenses. Making promise after promise about when they would call me or pay or do anything. Paying expenses to a different organisation. Telling me that, as they had paid someone, it was now up to me to contact the third party and ask them to transfer the money to me (because every organisation is just waiting for calls from random strangers demanding cash). Then I had to write a report about the way the trust was working from the point of view of patients. The trust asked for copies of the independent report (so not unsolicited) but when they got it the Chief Exec told me to change the format and content - fuck off, it is my report, published by my organisation and it is not up to you to tell me what to write or correct me like I am a junior member of your staff.

Lower levels of admin were unprofessional and careless (in every sense of the word). Upper levels were arrogant and motivated primarily by politics in which they were so busy inspecting their own navels that the raison d'etre became reacting to the latest initiative instead of providing healthcare.

I don't volunteer for the NHS anymore - can you guess why?

Sadly I do think it's ingrained in the culture of the NHS - with over inflated management and under resourced admin, and admin getting defensive / patronising when challenged because they are the front line.

Can someone help me with the right words to use when speaking to the secretary next week? I'm usually articulate and strong minded in my own work, but when it comes to dealing with my own health I get tongue tied and always come across weak and get walked over.

So if the secretary launches into her spiel of 'I know it's hard but there are 100s of other women in the same boat you know' what I want to say is 'I fully understand and appreciate that, but I'm concerned with my case only. I have now breached the 18 week pathway by xx weeks. My notes should have been with Mr Consultant since February, so he has had ample time to sign them off. Please can you inform me when he has done that'. Would that be rude?

And then when I speak to the team who arrange the surgery dates - how can I word it that I've breached the waiting times and I'd like to ensure I am listed from the date I was seen? Is that a reasonable thing to ask for, even if it's not their fault that they won't receive my notes until next week?

FWIW, I know several other people (all under different hospitals) who have had the same experiences as me - they have had to chase appointments, and become a pain in the arse to finally get a date for surgery. In all cases, action has only been taken once a formal complaint has been made. It's appalling.

On two occasions, both myself and my mother have received appointment letters on the day of the appointment. Luckily, in both cases, we knew about the appointments ahead of time because we had been phoning up to chase appointments. But if we hadn't? We would have missed our appointments and been black marked for it.

I dunno and as a hcp myself I find it as annoying as hell. Paperwork is stuck in the 1950s and I agree going paperless will mpbe a major leap forward for the better.

Years ago I was due an op and missed my pre op consult as I never had a letter. Consultant passed me at work and asked where I'd been. I was told I would be sent another date. I kept hassling the secretary at regular intervals. Which culminated in me ringing up one afternoon to ask if there was any news, I could hear tap, tap, tap of the computer......then it went quiet.....then she came back on the line and said that my operation was the following day. The letter arrived a week later, dated the day after my operation! Apparantly they had a nine week backlog in letters and the Drs were worrying why nobody was turning up for appts or operations!

This is why I shouldn't bother posting on Nhs threads. There's always somebody who wants to turn up and hurl abuse at managers.

FYI I do set standards for my team and work to improve patient experience as well as operational efficiency but I cannot stand behind every person, every minute of the day. I'm too busy hiding in my office counting my gold you see.

Good luck op

The NHS actually has a low number of managers for the size of the organisation. www.kingsfund.org.uk/topics/nhs-reform/mythbusters/nhs-managers

I agree nhs admin jobs are poorly paid. I see them being advertised circa 15k. I was earning 11k as an office junior twenty years ago. I don't think 15k will attract a decent administrator who round here could get over 20k in the private sector.

Simon that's appalling!

But I don't understand how on earth those in charge of managing the system wouldn't pick up on that. Surely, if people weren't turning up for their operations, someone would realize something was wrong?! What the hell is wrong with people!!

That sort of thing fills me with anxiety, I like to plan ahead and I'd really struggle if I was given such short notice about my operation.

The other thing I can't get my head around is the 'turn up at 7am and we'll see if we have a bed for your operation' business. When I had my last op, I arrived at 7 to be told by the nurse "Well how would I know if there are beds, I've only just come on shift!".... errr well why the hell tell people to get here so early then?

Then I was seen by the consultant on the morning of my op, and he told me that he still didn't know if my op would go ahead that day because of lack of beds, but that he had to carry on with his checks under the hope that it would.

Now I get that there's a shortage of beds - but how on earth does it make economic sense to be sending the most highly paid member of staff in the ward trundling around carrying out pre-op conversations with patients who might then get sent home? I'd rather he spent his valuable time signing letters until he was sure he'd be needed!!!

When I went off for surgery at 1pm, I walked past the waiting room to see a woman who had arrived with me at 7am still sitting there in her coat waiting . Bearing in mind we'd all been nil-by-mouth since the night before, its just bloody cruel.

I'm really sorry Northern , I hope you haven't been offended. I found your reply really helpful and I'm really grateful for your insights. It certainly sounds like the system that you manage is one of the good ones.

I think it's just frustration, and a general belief that all public services are run with a top heavy approach. Mine certainly is, and my views are probably tarnished by the way I've been treated in my own job.

Please don't be offended, and thank you again for the really useful info you gave me upthread.

I don't think you are BU, OP.
Around this time last year my right ankle began to swell. Went to local walk in centre on the weekend as couldn't walk on it at all. They said it was a sprain and blamed my weight. Was told RICE for a few weeks.

Three weeks later when no improvement contacted GP. Referred to MSK, two month waiting list. They kept insisting I'd injured it despite me promising I hadn't (think they though might be a drunken injury - some hope!).

Had MRI, bloke from MSK still blaming injury I hadn't had even though by now other ankle starting to swell along with right wrist. Have strong family history of auto immune disease including mum with rheumatoid arthritis. By now almost unable to walk.

MSK reluctantly gave in to my demand to be seen by rheumatologist. Given a date 3 months in future. Rang consultants secretary, explained concerns and asked for any cancellation, even if on the day.

6 months after symptoms first occurred I got a call asking if I could get to Epsom (about an hour away) that morning. Grabbed it, was dx with rheumatoid arthritis which even now six months later isn't under control.

Thing is as I had to be referred twice in this process (because apparently there was a typo in a letter stating that I'd had an injury instead of I'd NOT had an injury) and also because two referral letters went adrift AND the wrong form got filled in it took way longer than it was supposed to. If I'd not been on the phone weekly I reckon I'd still be waiting.

I think we also have a generation of moderately bright kids who in the past would have done decent admin jobs, who go off and do something like a worthless media degree instead. My fairly bright niece chose admin instead of Uni and the NHS department she works for treat her like the second coming: they are so used to getting useless admin people.

I think the same applies to tradesmen actually: when I was a kid they were the lads in set three or something. These days the lads from set three are working in a call centre with their film studies degree and the joiner's lad doesn't seem able to use a tape measure.

Your post is so familiar! I had almost identical issues trying to see a consultant, it was like something from a comedy (only not very funny). What's really tragic is thinking about all the quiet, non-complaining people who presumably just don't get seen. I only managed to eventually get results because of sheer persistence and determination.

I think you have a point there Tinkly I was thinking this just this week. We've had a lovely young lady working with us as an admin assistant, and I heard someone talking about her in an almost apologetic tone as in "Oh she could have gone to Uni, but she decided to do admin.. she might still go to Uni at another time" as if choosing to do admin - and be good at it, were a lesser choice to be ashamed of.

The implication being that ALL young people MUST go to uni these days, even if they don't want to. I have huge respect for any young person who decides to go against the grain and make positive career choices that suit them.

There also doesn't seem to be career progression from actually doing an admin role to managing an admin function. It is relatively unusually to find managers who have done the job of the people they are managing. They seem to arrive, fully fledged, as managers.

PerspicaciaTick That may well be the case in many NHS organisations but I know many, many non-clinical managers who started out as appointment clerks, ward clerks, med secs, filing clerks, coders etc. etc.

What do people class as a manager though? A Band 4 Team Leader, a Band 5 Records Library Team Leader, a Band 6 Coding Office Team Leader, a Band 6 Deputy Service lead? Or is it just Band 8 and above?

I think it is true of a lot of very large organisations, not just the NHS. And I don't think a tendency to focus on internal processes at the expense of providing an improving service to patients/customers is exclusive to the NHS either.
And I think very few patients would care whether a Band 4 or a Band 8 is actually, technically a manager - they would see a manager as being the person who could make a decision to fix their problem and follow through to the point where the problem is fixed.

Actually, I think some of the rudest NHS staff tend to be middle aged women who wouldn't have gone to college to get a media degree. The younger staff seem politer and more helpful to me.

I am sorry if I offended you Northern but I still think it is the responsibility of management to ensure customers are treated well in the first place. Time and again in recent years I have had hospital appointments and the doctors have been charming and helpful, nurses less so, hca's hmmm, and admin staff unbelievable. I think a lot of the problem is that one doesn't for sure know the role of the person you are dealing with and it's rude to squint to see the badge because staff don't introduce themselves except for the doctors. I suspect that's a purposeful thing so patients aren't too sure who they are dealing with and it covers up the gaps.

I would like to see posters in every department clearly noting:

Check blouse - admin
Green blouse/dress - cleaner/facilities
Pink blouse/dress HCA
Pale blue blouse/dress junior nurse (qualified)
Royal blue blouse/dress senior nurse/sister

And every member if staff should introduce themselves, "I am Jane Smith, gynaecology staff nurse, registered nurse, nursing assistant, phlebotomist, etc.". That to me is basic.. Just like "what would you like me to call you, may I use your first name". Rather than the assumption they may address people as a chum. Actually if someone is going to ask me confidential or intimate questions, no they may not - let's keep it professional. And don't address me by my first name please if the doctor is going to be addressed as Mr Bloggs or Dr Black. Since when was the patient subordinate to any other human being. My first name is fine, if every other member of NHS staff is addressed by theirs. It's an issue of equality.

I'm NHS admin and part of the problem is that there are just too many systems and processes ,all designed of course to make things more efficient when actually in practice things just get lost in the ever increasing 'system'.

I'm sorry sporners but that isn't an excuse for being rude to customers. If there's a problem, it needs to be identified and resolved. That's difficult when three admin are having a chat about another member of staff in front of a queue. I'm sorry you are probably had working and lovely but so many aren't and management don't deal with the issue. Why?

The whole process of managing bad performance/behaviour is extremely long winded and lengthy (as directed by HR to protect the employee and employer). I used to spend approximately 75% of my time on staffing issues rather than managing the services (improving efficiency etc.).

If managers don't witness rude behaviour and no one reports it, how do they get to hear about it? It's not possible to stand next to every member of staff all the time.

No, I agree, because I am HR but setting professional boundaries goes a very long way towards raising standards. As indeed does setting a good example and initiating a srvice orientated culture rather than one where patients are expected to be grateful because it's free. Capability is long winded and hard that's why good recruitment and robust probations should be ensured.

Beau I agree ,Having spent the last 12 years working for the NHS I have met some unbelievably rude & unhelpful admin( & medical staff). Maybe the fact that its the crap staff who always get promoted to management that has something to do with it .

The pressures put on staff and the skills required for a supposedly junior admin role are immense and maybe the ones that are any good get out PDQ ?

I've been working with some band 2 receptionists this week and TBH they do an awesome job ,multitasking dealing with the public whilst running around trying to ensure that all the stuff that no one ever knows about is still done. Believe me if you can be a (good) receptionist you can do anything.

Perhaps some of them need to become managers

I think decent admin is very underrated. 'Admin' is a very junior role and yet doing it well is actually quite skilful. Perhaps, like all these things, the fact that the majority of admin staff are women is what makes it so poorly paid. The ability to lift heavy things, or stand outside in poor weather for long periods of time, pays better than admin work.

Sympathies, I'm also an endo sufferer. I lived abroad for a while and it was well managed, regular scans, hormone treatment tweaked etc. Came back, was told by the GP that I wouldn't get any scans, no referral as I had a diagnosis, and I could just go on the pill. Not surprising, it's been pretty bad. I love the NHS but they really don't treat endo as seriously as it deserves.

NHS administration can be great. I've had a series of treatments including surgery, over the last 4 years, that's included at least 3 different parts of 2 hospitals. It's taken a long time (non-urgent) but faultless. Only once have my notes been delayed (not lost).

I've given up with my local gynae department. I was referred (for endo) in earlyJanuary, GP wrote again end Jan to say that the appointment also needed to cover recurrent miscarriage now. 2 months later, I got a letter to tell me that they had my referral. At the same time I got pregnant again - GP faxed the consultant to ask him to a) see me urgently and b) provide him with advice for my case. No response. Over 3 months have now passed and still no appointment letter.